title: Ethical aspects of directly observed treatment for tuberculosis: a cross-cultural comparison.
abstract: BACKGROUND
  Tuberculosis is a major global public health challenge, and a majority of countries have adopted a version of the global strategy to fight Tuberculosis, Directly Observed Treatment, Short Course (DOTS). Drawing on results from research in Ethiopia and Norway, the aim of this paper is to highlight and discuss ethical aspects of the practice of Directly Observed Treatment (DOT) in a cross-cultural perspective.
  
  
  CONCLUSIONS
  Research from Ethiopia and Norway demonstrates that the rigid enforcement of directly observed treatment conflicts with patient autonomy, dignity and integrity. The treatment practices, especially when imposed in its strictest forms, expose those who have Tuberculosis to extra burdens and costs. Socially disadvantaged groups, such as the homeless, those employed as day labourers and those lacking rights as employees, face the highest burdens.
  
  
  CONCLUSIONS
  From an ethical standpoint, we argue that a rigid practice of directly observed treatment is difficult to justify, and that responsiveness to social determinants of Tuberculosis should become an integral part of the management of Tuberculosis.
authors.affiliation: Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College, PB 4, St. Olavs Plass, 0130, Oslo, Norway. mette.sagbakken@hioa.no
authors.forename: Mette
authors.initials: M
authors.lastname: Sagbakken
authors.forename: Jan C
authors.initials: JC
authors.lastname: Frich
authors.forename: Gunnar A
authors.initials: GA
authors.lastname: Bjune
authors.forename: John D H
authors.initials: JD
authors.lastname: Porter
mesh_terms: D000328:Adult; D000368:Aged; D003431:Cross-Cultural Comparison; D003466:Cultural Characteristics; D023801:Directly Observed Therapy / Q000941:ethics*; D019353:Endemic Diseases; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006806:Human Rights; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D009723:Nurse-Patient Relations; D026684:Personal Autonomy; D028723:Personhood; D011637:Public Health Nursing / Q000941:ethics; D012935:Social Justice; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology; D035862:Vulnerable Populations